BACKGROUND It is evident that an accurate evaluation of T and N stage rectal cancer is essential for treatment planning.It has not been extensively investigated whether texture features derived from diffusion-weighted...BACKGROUND It is evident that an accurate evaluation of T and N stage rectal cancer is essential for treatment planning.It has not been extensively investigated whether texture features derived from diffusion-weighted imaging(DWI)images and apparent diffusion coefficient(ADC)maps are associated with the extent of local invasion(pathological stage T1-2 vs T3-4)and nodal involvement(pathological stage N0 vs N1-2)in rectal cancer.AIM To predict different stages of rectal cancer using texture analysis based on DWI images and ADC maps.METHODS One hundred and fifteen patients with pathologically proven rectal cancer,who underwent preoperative magnetic resonance imaging,including DWI,were enrolled,retrospectively.The ADC measurements(ADCmean,ADCmin,ADCmax)as well as texture features,including the gray level co-occurrence matrix parameters,the gray level run-length matrix parameters and wavelet parameters were calculated based on DWI(b=0 and b=1000)images and the ADC maps.Independent sample t-tests or Mann-Whitney U tests were used for statistical analysis.Multivariate logistic regression analysis was conducted to establish the models.The predictive performance was validated by receiver operating characteristic curve analysis.RESULTS Dissimilarity,sum average,information correlation and run-length nonuniformity from DWIb=0 images,gray level nonuniformity,run percentage and run-length nonuniformity from DWIb=1000 images,and dissimilarity and run percentage from ADC maps were found to be independent predictors of local invasion(stage T3-4).The area under the operating characteristic curve of the model reached 0.793 with a sensitivity of 78.57%and a specificity of 74.19%.Sum average,gray level nonuniformity and the horizontal components of symlet transform(SymletH)from DWIb=0 images,sum average,information correlation,long run low gray level emphasis and SymletH from DWIb=1000 images,and ADCmax,ADCmean and information correlation from ADC maps were identified as independent predictors of nodal involvement.The area under the operating characteristic curve of the model reached 0.802 with a sensitivity of 80.77%and a specificity of 68.25%.CONCLUSION Texture features extracted from DWI images and ADC maps are useful clues for predicting pathological T and N stages in rectal cancer.展开更多
Objective: The aim of this study was to predict tumor progression in patients with hepatocellular carcinoma(HCC) treated with radiofrequency ablation(RFA) using histogram analysis of apparent diffusion coefficients(AD...Objective: The aim of this study was to predict tumor progression in patients with hepatocellular carcinoma(HCC) treated with radiofrequency ablation(RFA) using histogram analysis of apparent diffusion coefficients(ADC).Methods: Breath-hold diffusion weighted imaging(DWI) was performed in 64 patients(33 progressive and 31 stable) with biopsy-proven HCC prior to RFA. All patients had pre-treatment magnetic resonance imaging(MRI)and follow-up computed tomography(CT) or MRI. The ADC values(ADC_(10), ADC_(30_, ADC_(median) and ADC_(max))were obtained from the histogram's 10 th, 30 th, 50 th and 100 th percentiles. The ratios of ADC_(10), ADC_(30_,ADCmedian and ADCmax to the mean non-lesion area-ADC(RADC_(10), RADC_(30_, RADC_(median), and RADC_(max)) were calculated. The two patient groups were compared. Key predictive factors for survival were determined using the univariate and multivariate analysis of the Cox model. The Kaplan-Meier survival analysis was performed, and pairs of survival curves based on the key factors were compared using the log-rank test.Results: The ADC_(30_, ADCmedian, ADCmax, RADC_(30_, RADC_(median), and RADC_(max) were significantly larger in the progressive group than in the stable group(P<0.05). The median progression-free survival(PFS) was 22.9 months for all patients. The mean PFS for the stable and progressive groups were 47.7±1.3 and 9.8±1.3 months,respectively. Univariate analysis indicated that RADC_(10), RADC_(30_, and RADC_(median) were significantly correlated with the PFS [hazard ratio(HR)=31.02, 43.84, and 44.29, respectively, P<0.05 for all]. Multivariate analysis showed that RADCmedian was the only independent predictor of tumor progression(P=0.04). And the cutoff value of RADC_(median) was 0.71.Conclusions: Pre-RFA ADC histogram analysis might serve as a useful biomarker for predicting tumor progression and survival in patients with HCC treated with RFA.展开更多
BACKGROUND For periampullary adenocarcinoma,the histological subtype is a better prognostic predictor than the site of tumor origin.Intestinal-type periampullary adenocarcinoma(IPAC)is reported to have a better progno...BACKGROUND For periampullary adenocarcinoma,the histological subtype is a better prognostic predictor than the site of tumor origin.Intestinal-type periampullary adenocarcinoma(IPAC)is reported to have a better prognosis than the pancreatobiliary-type periampullary adenocarcinoma(PPAC).However,the classification of histological subtypes is difficult to determine before surgery.Apparent diffusion coefficient(ADC)histogram analysis is a noninvasive,nonenhanced method with high reproducibility that could help differentiate the two subtypes.AIM To investigate whether volumetric ADC histogram analysis is helpful for distinguishing IPAC from PPAC.METHODS Between January 2015 and October 2018,476 consecutive patients who were suspected of having a periampullary tumor and underwent magnetic resonance imaging(MRI)were reviewed in this retrospective study.Only patients who underwent MRI at 3.0 T with different diffusion-weighted images(b-values=800 and 1000 s/mm^2)and who were confirmed with a periampullary adenocarcinoma were further analyzed.Then,the mean,5th,10th,25th,50th,75th,90th,and 95th percentiles of ADC values and ADCmin,ADCmax,kurtosis,skewness,and entropy were obtained from the volumetric histogram analysis.Comparisons were made by an independent Student's t-test or Mann-Whitney U test.Multiple-class receiver operating characteristic curve analysis was performed to determine and compare the diagnostic value of each significant parameter.RESULTS In total,40 patients with histopathologically confirmed IPAC(n=17)or PPAC(n=23)were enrolled.The mean,5th,25th,50th,75th,90th,and 95th percentiles and ADCmax derived from ADC1000 were significantly lower in the PPAC group than in the IPAC group(P<0.05).However,values derived from ADC800 showed no significant difference between the two groups.The 75th percentile of ADC1000 values achieved the highest area under the curve(AUC)for differentiating IPAC from PPAC(AUC=0.781;sensitivity,91%;specificity,59%;cut-off value,1.50×10^-3 mm^2/s).CONCLUSION Volumetric ADC histogram analysis at a b-value of 1000 s/mm2 might be helpful for differentiating the histological subtypes of periampullary adenocarcinoma before surgery.展开更多
BACKGROUND Whole-tumor apparent diffusion coefficient(ADC)histogram analysis is relevant to predicting the neoadjuvant chemoradiation therapy(nCRT)response in patients with locally advanced rectal cancer(LARC).AIM To ...BACKGROUND Whole-tumor apparent diffusion coefficient(ADC)histogram analysis is relevant to predicting the neoadjuvant chemoradiation therapy(nCRT)response in patients with locally advanced rectal cancer(LARC).AIM To evaluate the performance of ADC histogram-derived parameters for predicting the outcomes of patients with LARC.METHODS This is a single-center,retrospective study,which included 48 patients with LARC.All patients underwent a pre-treatment magnetic resonance imaging(MRI)scan for primary tumor staging and a second restaging MRI for response evaluation.The sample was distributed as follows:18 responder patients(R)and 30 non-responders(non-R).Eight parameters derived from the whole-lesion histogram analysis(ADCmean,skewness,kurtosis,and ADC10^(th),25^(th),50^(th),75^(th),90^(th) percentiles),as well as the ADCmean from the hot spot region of interest(ROI),were calculated for each patient before and after treatment.Then all data were compared between R and non-R using the Mann-Whitney U test.Two measures of diagnostic accuracy were applied:the receiver operating characteristic curve and the diagnostic odds ratio(DOR).We also reported intra-and interobserver variability by calculating the intraclass correlation coefficient(ICC).RESULTS Post-nCRT kurtosis,as well as post-nCRT skewness,were significantly lower in R than in non-R(both P<0.001,respectively).We also found that,after treatment,R had a larger loss of both kurtosis and skewness than non-R(Δ%kurtosis and Δ skewness,P<0.001).Other parameters that demonstrated changes between groups were post-nCRT ADC10^(th),Δ%ADC10^(th),Δ%ADCmean,and ROIΔ%ADCmean.However,the best diagnostic performance was achieved byΔ%kurtosis at a threshold of 11.85%(Area under the receiver operating characteristic curve[AUC]=0.991,DOR=376),followed by post-nCRT kurtosis=0.78×10^(-3)mm^(2)/s(AUC=0.985,DOR=375.3),Δskewness=0.16(AUC=0.885,DOR=192.2)and post-nCRT skewness=1.59×10^(-3)mm^(2)/s(AUC=0.815,DOR=168.6).Finally,intraclass correlation coefficient analysis showed excellent intraobserver and interobserver agreement,ensuring the implementation of histogram analysis into routine clinical practice.CONCLUSION Whole-tumor ADC histogram parameters,particularly kurtosis and skewness,are relevant biomarkers for predicting the nCRT response in LARC.Both parameters appear to be more reliable than ADCmean from one-slice ROI.展开更多
There have been numerous studies done to explore the diagnostic performance of quanti- tative diffusion-weighted （DW） MR imaging to differentiate between benign and malignant pancre- atic masses. However, the result...There have been numerous studies done to explore the diagnostic performance of quanti- tative diffusion-weighted （DW） MR imaging to differentiate between benign and malignant pancre- atic masses. However, the results have been inconsistent. We performed a meta-analysis to investigate whether DW-MR imaging can differentiate between these two diseases. Databases including MEDLINE, EMBASE and Cochrane Library were utilized to find relevant articles published between January 2001 and January 2014. A Stata version 12.0 and a Meta-Disc version 1.4 were used to de- scribe primary results. Twelve studies with 594 patients, which fulfilled the inclusion criteria, were enrolled for the analysis. The pooled sensitivity and specificity of DW imaging was 0.91 （95% CI： 0.84, 0.95） and 0.86 （95% CI： 0.76, 0.93） respectively. The area under the curve of the summary re- ceiver operating characteristic was 0.95 （95% CI： 0.93, 0.96）. The results indicated that DW imaging might be a valuable tool for differentiating benign and malignant pancreatic masses.展开更多
BACKGROUND The accuracy of discriminating pT3a from pT3b-c rectal cancer using highresolution magnetic resonance imaging(MRI)remains unsatisfactory,although texture analysis(TA)could improve such discrimination.AIM To...BACKGROUND The accuracy of discriminating pT3a from pT3b-c rectal cancer using highresolution magnetic resonance imaging(MRI)remains unsatisfactory,although texture analysis(TA)could improve such discrimination.AIM To investigate the value of TA on apparent diffusion coefficient(ADC)maps in differentiating pT3a rectal adenocarcinomas from pT3b-c tumors.METHODS This was a case-control study of 59 patients with pT3 rectal adenocarcinoma,who underwent diffusion-weighted imaging(DWI)between October 2016 and December 2018.The inclusion criteria were:(1)Proven pT3 rectal adenocarcinoma;(2)Primary MRI including high-resolution T2-weighted image(T2WI)and DWI;and(3)Availability of pathological reports for surgical specimens.The exclusion criteria were:(1)Poor image quality;(2)Preoperative chemoradiation therapy;and(3)A different pathological type.First-order(ADC values,skewness,kurtosis,and uniformity)and second-order(energy,entropy,inertia,and correlation)texture features were derived from whole-lesion ADC maps.Receiver operating characteristic curves were used to determine the diagnostic value for pT3b-c tumors.RESULTS The final study population consisted of 59 patients(34 men and 25 women),with a median age of 66 years(range,41-85 years).Thirty patients had pT3a,24 had pT3b,and five had pT3c.Among the ADC first-order textural differences between pT3a and pT3b-c rectal adenocarcinomas,only skewness was significantly lower in the pT3a tumors than in pT3b-c tumors.Among the ADC second-order textural differences,energy and entropy were significantly different between pT3a and pT3b-c rectal adenocarcinomas.For differentiating pT3a rectal adenocarcinomas from pT3b-c tumors,the areas under the curves(AUCs)of skewness,energy,and entropy were 0.686,0.657,and 0.747,respectively.Logistic regression analysis of all three features yielded a greater AUC(0.775)in differentiating pT3a rectal adenocarcinomas from pT3b-c tumors(69.0%sensitivity and 83.3%specificity).CONCLUSION TA features derived from ADC maps might potentially differentiate pT3a rectal adenocarcinomas from pT3b-c tumors.展开更多
Diffusion-weighted imaging(DWI)as a new technique of magnetic resonance imaging(MRI)is used to detect focal hepatic lesions.This study was designed to evaluate the significance of DWI to differentiate focal hepatic le...Diffusion-weighted imaging(DWI)as a new technique of magnetic resonance imaging(MRI)is used to detect focal hepatic lesions.This study was designed to evaluate the significance of DWI to differentiate focal hepatic lesions less than 3 cm in diameter by the quantitation of apparent diffusion coefficient(ADC)values.METHODS:DWI using 1.5T MRI scanner unit was performed with a spin-echo single-shot echo planar imaging(EPI)in 56 cases of small focal hepatic lesions,including hepatocellular carcinoma(11),hepatic metastatic tumor(15),hepatic cavernous hemangioma(14),and hepatic cyst(16).The ADC values of these lesions were calculated respectively.The ratios of the ADC values of lesion/liver in hepatocellular carcinomas and hepatic metastatic tumors were also estimated.RESULTS:The mean ADC values(mm2/s)were(0.93±0.06)×10-3 in hepatocellular carcinomas,(1.09±0.18)×10-3 in hepatic metastatic tumors,(1.95±0.38)×10-3 in hepatic cavernous hemangiomas,and(3.18±0.33)×10-3 in hepatic cysts.The ratios of ADC values of lesion/liver were 0.90±0.06 and 1.15±0.14 in hepatocellular carcinoma and hepatic metastatic tumors respectively,which were significantly different(P<0.05).CONCLUSION:The measurement of ADC values and the ratios of ADC values of lesion/liver are helpful in MR diagnosis and differentiation of focal hepatic lesions.展开更多
Prostate cancer(PCa)imaging forms an important part of PCa clinical management.Magnetic resonance imaging is the modality of choice for prostate imaging.Most of the current imaging assessment is qualitative i.e.,based...Prostate cancer(PCa)imaging forms an important part of PCa clinical management.Magnetic resonance imaging is the modality of choice for prostate imaging.Most of the current imaging assessment is qualitative i.e.,based on visual inspection and thus subjected to inter-observer disagreement.Quantitative imaging is better than qualitative assessment as it is more objective,and standardized,thus improving interobserver agreement.Apart from detecting PCa,few quantitative parameters may have potential to predict disease aggressiveness,and thus can be used for prognosis and deciding the course of management.There are various magnetic resonance imaging-based quantitative parameters and few of them are already part of PIRADS v.2.1.However,there are many other parameters that are under study and need further validation by rigorous multicenter studies before recommending them for routine clinical practice.This review intends to discuss the existing quantitative methods,recent developments,and novel techniques in detail.展开更多
Background:Neoadjuvant chemotherapy(NCT)alone can achieve comparable treatment outcomes to chemoradiotherapy in locally advanced rectal cancer(LARC)patients.This study aimed to investigate the value of texture analysi...Background:Neoadjuvant chemotherapy(NCT)alone can achieve comparable treatment outcomes to chemoradiotherapy in locally advanced rectal cancer(LARC)patients.This study aimed to investigate the value of texture analysis(TA)in apparent diffusion coefficient(ADC)maps for identifying non-responders to NCT.Methods:This retrospective study included patients with LARC after NCT,and they were categorized into nonresponse group(pTRG 3)and response group(pTRG 0-2)based on pathological tumor regression grade(pTRG).Predictive texture features were extracted from pre-and post-treatment ADC maps to construct a TA model using RandomForest.The ADC model was developed by manually measuring pre-and post-treatment ADC values and calculating their changes.Simultaneously,subjective evaluations based on magnetic resonance imaging assessment of TRG were performed by two experienced radiologists.Model performance was compared using the area under the curve(AUC)and DeLong test.Results:A total of 299 patients from two centers were divided into three cohorts:the primary cohort(center A;n=194,with 36 non-responders and 158 responders),the internal validation cohort(center A;n=49,with 9 non-responders)and external validation cohort(center B;n=56,with 33 non-responders).The TA model was constructed by post_mean,mean_change,post_skewness,post_entropy,and entropy_change,which outperformed both the ADC model and subjective evaluations with an impressive AUC of 0.997(95%confidence interval[CI],0.975-1.000)in the primary cohort.Robust performances were observed in internal and external validation cohorts,with AUCs of 0.919(95%CI,0.805-0.978)and 0.938(95%CI,0.840-0.985),respectively.Conclusions:The TA model has the potential to serve as an imaging biomarker for identifying nonresponse to NCT in LARC patients,providing a valuable reference for these patients considering additional radiation therapy.展开更多
目的分析动态增强磁共振成像(dynamic contrast enhanced magnetic resonance imaging,DCE-MRI)定量参数与表观扩散系数(apparent diffusion coefficient,ADC)联合诊断外周带前列腺癌的价值。方法选取2022年4月—2024年4月丹江口市第一...目的分析动态增强磁共振成像(dynamic contrast enhanced magnetic resonance imaging,DCE-MRI)定量参数与表观扩散系数(apparent diffusion coefficient,ADC)联合诊断外周带前列腺癌的价值。方法选取2022年4月—2024年4月丹江口市第一医院收治的168例患者为研究对象,其中83例外周带前列腺癌患者纳入观察组,85例前列腺炎患者纳入对照组,另将同期于丹江口市第一医院行体检的88名健康体检者纳入健康组,均行DCE-MRI、扩散加权成像(diffusion weighted imaging,DWI)扫描,对比3组速率常数(rate constant,K_(ep))、容积转运常数(volume transfer constant,K_(trans))、血管外细胞外间隙体积分数(fractional extravascular extracellular space volume,V_(e))及ADC值;另描绘受试者工作曲线(receiver operating characteristic curve,ROC),分析K_(ep)、K_(trans)、V_(e)及ADC值单独或联合诊断外周带前列腺癌的价值。结果观察组的K_(ep)为(0.78±0.16)min、K_(trans)为(0.61±0.13)min,高于对照组的(0.53±0.10)min、(0.28±0.05)min,健康组的(0.14±0.02)min、(0.18±0.01)min,差异有统计学意义(P<0.001);观察组的V_(e)为(0.14±0.02)、ADC为(0.82±0.19)×10^(-3)mm^(2)/s,低于对照组的(0.18±0.02)、(1.06±0.18)×10^(-3)mm^(2)/s,健康组的(0.38±0.06)、(1.34±0.15)×10^(-3)mm^(2)/s,差异有统计学意义(P<0.001)。ROC结果显示,K_(ep)、K_(trans)、V_(e)及ADC值联合诊断外周带前列腺癌的曲线下面积(area under the curve,AUC)高于四者单一诊断(P<0.001)。结论DCE-MRI定量参数联合ADC可有效地诊断出外周带前列腺癌,存在一定的诊断价值。展开更多
目的:探讨第2版前列腺影像报告和数据系统(prostate imaging reporting and data system version 2,PI-RADS V2评分联合表观扩散系数(apparent diffusion coefficient,ADC)图像定量参数对外周带前列腺癌的诊断价值。方法:回顾性搜集50...目的:探讨第2版前列腺影像报告和数据系统(prostate imaging reporting and data system version 2,PI-RADS V2评分联合表观扩散系数(apparent diffusion coefficient,ADC)图像定量参数对外周带前列腺癌的诊断价值。方法:回顾性搜集50例前列腺多参数磁共振成像(multiparametric MRI,mpMRI)检查提示存在外周带结节的患者,且均经穿刺活检获得病理诊断。由两名高年资影像科医师根据PI-RADS V2标准对病灶进行定位及评分,分别利用后处理软件在ADC图像上分析、计算对应病灶区的12种ADC图像定量参数。根据病理结果将病灶分为癌灶组和良性病灶组。比较两组病灶各ADC定量参数的差异,对组间差异有统计学意义的参数采用逻辑回归逐步法拟合建模,通过受试者工作特征(receiver operating characteristic,ROC)曲线和决策曲线分析(decision curve analysis,DCA)评价不同方法的诊断效能和临床受益。结果:最终共获得外周带癌灶28个、良性病灶25个。PI-RADS V2评分、ADC模型及联合模型(PI-RADS V2评分+ADC模型)区分外周带癌灶和良性病灶的ROC曲线下面积、敏感度、特异度分别为0.803,60.71%,92.00%;0.857,89.29%,76.00%;0.891,71.43%,92.00%,联合模型较PI-RADS V2评分的诊断效能有明显提升(P=0.012),且在阈概率0.05～0.27和0.46～0.81范围内该联合模型具有相对最佳的总体净受益率,优于PI-RADS V2评分。结论:PI-RADS V2联合ADC图像定量分析能显著提高其区分外周带前列腺癌和良性病变的诊断效能,并改善临床受益。展开更多
基金Supported by Research and Development Foundation for Major Science and Technology from Shenyang,No.19-112-4-105Big Data Foundation for Health Care from China Medical University,No.HMB201902105Natural Fund Guidance Plan from Liaoning,No.2019-ZD-0743.
文摘BACKGROUND It is evident that an accurate evaluation of T and N stage rectal cancer is essential for treatment planning.It has not been extensively investigated whether texture features derived from diffusion-weighted imaging(DWI)images and apparent diffusion coefficient(ADC)maps are associated with the extent of local invasion(pathological stage T1-2 vs T3-4)and nodal involvement(pathological stage N0 vs N1-2)in rectal cancer.AIM To predict different stages of rectal cancer using texture analysis based on DWI images and ADC maps.METHODS One hundred and fifteen patients with pathologically proven rectal cancer,who underwent preoperative magnetic resonance imaging,including DWI,were enrolled,retrospectively.The ADC measurements(ADCmean,ADCmin,ADCmax)as well as texture features,including the gray level co-occurrence matrix parameters,the gray level run-length matrix parameters and wavelet parameters were calculated based on DWI(b=0 and b=1000)images and the ADC maps.Independent sample t-tests or Mann-Whitney U tests were used for statistical analysis.Multivariate logistic regression analysis was conducted to establish the models.The predictive performance was validated by receiver operating characteristic curve analysis.RESULTS Dissimilarity,sum average,information correlation and run-length nonuniformity from DWIb=0 images,gray level nonuniformity,run percentage and run-length nonuniformity from DWIb=1000 images,and dissimilarity and run percentage from ADC maps were found to be independent predictors of local invasion(stage T3-4).The area under the operating characteristic curve of the model reached 0.793 with a sensitivity of 78.57%and a specificity of 74.19%.Sum average,gray level nonuniformity and the horizontal components of symlet transform(SymletH)from DWIb=0 images,sum average,information correlation,long run low gray level emphasis and SymletH from DWIb=1000 images,and ADCmax,ADCmean and information correlation from ADC maps were identified as independent predictors of nodal involvement.The area under the operating characteristic curve of the model reached 0.802 with a sensitivity of 80.77%and a specificity of 68.25%.CONCLUSION Texture features extracted from DWI images and ADC maps are useful clues for predicting pathological T and N stages in rectal cancer.
基金supported by CAMS Innovation Fund for Medical Sciences (CIFMS) (No. 2016-I2M-1-001)PUMC Youth Fund (No. 2017320010)Beijing Hope Run Fund of Cancer Foundation of China (No. LC2016B15)
文摘Objective: The aim of this study was to predict tumor progression in patients with hepatocellular carcinoma(HCC) treated with radiofrequency ablation(RFA) using histogram analysis of apparent diffusion coefficients(ADC).Methods: Breath-hold diffusion weighted imaging(DWI) was performed in 64 patients(33 progressive and 31 stable) with biopsy-proven HCC prior to RFA. All patients had pre-treatment magnetic resonance imaging(MRI)and follow-up computed tomography(CT) or MRI. The ADC values(ADC_(10), ADC_(30_, ADC_(median) and ADC_(max))were obtained from the histogram's 10 th, 30 th, 50 th and 100 th percentiles. The ratios of ADC_(10), ADC_(30_,ADCmedian and ADCmax to the mean non-lesion area-ADC(RADC_(10), RADC_(30_, RADC_(median), and RADC_(max)) were calculated. The two patient groups were compared. Key predictive factors for survival were determined using the univariate and multivariate analysis of the Cox model. The Kaplan-Meier survival analysis was performed, and pairs of survival curves based on the key factors were compared using the log-rank test.Results: The ADC_(30_, ADCmedian, ADCmax, RADC_(30_, RADC_(median), and RADC_(max) were significantly larger in the progressive group than in the stable group(P<0.05). The median progression-free survival(PFS) was 22.9 months for all patients. The mean PFS for the stable and progressive groups were 47.7±1.3 and 9.8±1.3 months,respectively. Univariate analysis indicated that RADC_(10), RADC_(30_, and RADC_(median) were significantly correlated with the PFS [hazard ratio(HR)=31.02, 43.84, and 44.29, respectively, P<0.05 for all]. Multivariate analysis showed that RADCmedian was the only independent predictor of tumor progression(P=0.04). And the cutoff value of RADC_(median) was 0.71.Conclusions: Pre-RFA ADC histogram analysis might serve as a useful biomarker for predicting tumor progression and survival in patients with HCC treated with RFA.
基金Supported by the National Natural Science Foundation of China,No.81701657,No.81571642,No.81801695,and No.81771801the Fundamental Research Funds for the Central Universities,No.2017KFYXJJ126
文摘BACKGROUND For periampullary adenocarcinoma,the histological subtype is a better prognostic predictor than the site of tumor origin.Intestinal-type periampullary adenocarcinoma(IPAC)is reported to have a better prognosis than the pancreatobiliary-type periampullary adenocarcinoma(PPAC).However,the classification of histological subtypes is difficult to determine before surgery.Apparent diffusion coefficient(ADC)histogram analysis is a noninvasive,nonenhanced method with high reproducibility that could help differentiate the two subtypes.AIM To investigate whether volumetric ADC histogram analysis is helpful for distinguishing IPAC from PPAC.METHODS Between January 2015 and October 2018,476 consecutive patients who were suspected of having a periampullary tumor and underwent magnetic resonance imaging(MRI)were reviewed in this retrospective study.Only patients who underwent MRI at 3.0 T with different diffusion-weighted images(b-values=800 and 1000 s/mm^2)and who were confirmed with a periampullary adenocarcinoma were further analyzed.Then,the mean,5th,10th,25th,50th,75th,90th,and 95th percentiles of ADC values and ADCmin,ADCmax,kurtosis,skewness,and entropy were obtained from the volumetric histogram analysis.Comparisons were made by an independent Student's t-test or Mann-Whitney U test.Multiple-class receiver operating characteristic curve analysis was performed to determine and compare the diagnostic value of each significant parameter.RESULTS In total,40 patients with histopathologically confirmed IPAC(n=17)or PPAC(n=23)were enrolled.The mean,5th,25th,50th,75th,90th,and 95th percentiles and ADCmax derived from ADC1000 were significantly lower in the PPAC group than in the IPAC group(P<0.05).However,values derived from ADC800 showed no significant difference between the two groups.The 75th percentile of ADC1000 values achieved the highest area under the curve(AUC)for differentiating IPAC from PPAC(AUC=0.781;sensitivity,91%;specificity,59%;cut-off value,1.50×10^-3 mm^2/s).CONCLUSION Volumetric ADC histogram analysis at a b-value of 1000 s/mm2 might be helpful for differentiating the histological subtypes of periampullary adenocarcinoma before surgery.
文摘BACKGROUND Whole-tumor apparent diffusion coefficient(ADC)histogram analysis is relevant to predicting the neoadjuvant chemoradiation therapy(nCRT)response in patients with locally advanced rectal cancer(LARC).AIM To evaluate the performance of ADC histogram-derived parameters for predicting the outcomes of patients with LARC.METHODS This is a single-center,retrospective study,which included 48 patients with LARC.All patients underwent a pre-treatment magnetic resonance imaging(MRI)scan for primary tumor staging and a second restaging MRI for response evaluation.The sample was distributed as follows:18 responder patients(R)and 30 non-responders(non-R).Eight parameters derived from the whole-lesion histogram analysis(ADCmean,skewness,kurtosis,and ADC10^(th),25^(th),50^(th),75^(th),90^(th) percentiles),as well as the ADCmean from the hot spot region of interest(ROI),were calculated for each patient before and after treatment.Then all data were compared between R and non-R using the Mann-Whitney U test.Two measures of diagnostic accuracy were applied:the receiver operating characteristic curve and the diagnostic odds ratio(DOR).We also reported intra-and interobserver variability by calculating the intraclass correlation coefficient(ICC).RESULTS Post-nCRT kurtosis,as well as post-nCRT skewness,were significantly lower in R than in non-R(both P<0.001,respectively).We also found that,after treatment,R had a larger loss of both kurtosis and skewness than non-R(Δ%kurtosis and Δ skewness,P<0.001).Other parameters that demonstrated changes between groups were post-nCRT ADC10^(th),Δ%ADC10^(th),Δ%ADCmean,and ROIΔ%ADCmean.However,the best diagnostic performance was achieved byΔ%kurtosis at a threshold of 11.85%(Area under the receiver operating characteristic curve[AUC]=0.991,DOR=376),followed by post-nCRT kurtosis=0.78×10^(-3)mm^(2)/s(AUC=0.985,DOR=375.3),Δskewness=0.16(AUC=0.885,DOR=192.2)and post-nCRT skewness=1.59×10^(-3)mm^(2)/s(AUC=0.815,DOR=168.6).Finally,intraclass correlation coefficient analysis showed excellent intraobserver and interobserver agreement,ensuring the implementation of histogram analysis into routine clinical practice.CONCLUSION Whole-tumor ADC histogram parameters,particularly kurtosis and skewness,are relevant biomarkers for predicting the nCRT response in LARC.Both parameters appear to be more reliable than ADCmean from one-slice ROI.
基金supported by the Science Foundation for Distinguished Young Scholars of Sichuan Province,China(No.2012JQ0060)
文摘There have been numerous studies done to explore the diagnostic performance of quanti- tative diffusion-weighted （DW） MR imaging to differentiate between benign and malignant pancre- atic masses. However, the results have been inconsistent. We performed a meta-analysis to investigate whether DW-MR imaging can differentiate between these two diseases. Databases including MEDLINE, EMBASE and Cochrane Library were utilized to find relevant articles published between January 2001 and January 2014. A Stata version 12.0 and a Meta-Disc version 1.4 were used to de- scribe primary results. Twelve studies with 594 patients, which fulfilled the inclusion criteria, were enrolled for the analysis. The pooled sensitivity and specificity of DW imaging was 0.91 （95% CI： 0.84, 0.95） and 0.86 （95% CI： 0.76, 0.93） respectively. The area under the curve of the summary re- ceiver operating characteristic was 0.95 （95% CI： 0.93, 0.96）. The results indicated that DW imaging might be a valuable tool for differentiating benign and malignant pancreatic masses.
基金Jiangsu Provincial Medical Youth Talent,No.QNRC2016212Suzhou Clinical Special Disease Diagnosis and Treatment Program,No.LCZX201823+2 种基金Suzhou GuSu Medical Talent Project,No.GSWS2019077The Science and Technology Bureau of Changshu,No.CS201624(to Lu ZH)Jiangsu Committee of Health,No.H2018071(to Xia KJ).
文摘BACKGROUND The accuracy of discriminating pT3a from pT3b-c rectal cancer using highresolution magnetic resonance imaging(MRI)remains unsatisfactory,although texture analysis(TA)could improve such discrimination.AIM To investigate the value of TA on apparent diffusion coefficient(ADC)maps in differentiating pT3a rectal adenocarcinomas from pT3b-c tumors.METHODS This was a case-control study of 59 patients with pT3 rectal adenocarcinoma,who underwent diffusion-weighted imaging(DWI)between October 2016 and December 2018.The inclusion criteria were:(1)Proven pT3 rectal adenocarcinoma;(2)Primary MRI including high-resolution T2-weighted image(T2WI)and DWI;and(3)Availability of pathological reports for surgical specimens.The exclusion criteria were:(1)Poor image quality;(2)Preoperative chemoradiation therapy;and(3)A different pathological type.First-order(ADC values,skewness,kurtosis,and uniformity)and second-order(energy,entropy,inertia,and correlation)texture features were derived from whole-lesion ADC maps.Receiver operating characteristic curves were used to determine the diagnostic value for pT3b-c tumors.RESULTS The final study population consisted of 59 patients(34 men and 25 women),with a median age of 66 years(range,41-85 years).Thirty patients had pT3a,24 had pT3b,and five had pT3c.Among the ADC first-order textural differences between pT3a and pT3b-c rectal adenocarcinomas,only skewness was significantly lower in the pT3a tumors than in pT3b-c tumors.Among the ADC second-order textural differences,energy and entropy were significantly different between pT3a and pT3b-c rectal adenocarcinomas.For differentiating pT3a rectal adenocarcinomas from pT3b-c tumors,the areas under the curves(AUCs)of skewness,energy,and entropy were 0.686,0.657,and 0.747,respectively.Logistic regression analysis of all three features yielded a greater AUC(0.775)in differentiating pT3a rectal adenocarcinomas from pT3b-c tumors(69.0%sensitivity and 83.3%specificity).CONCLUSION TA features derived from ADC maps might potentially differentiate pT3a rectal adenocarcinomas from pT3b-c tumors.
基金This study was supported by the Natural Science Foundation of Guangdong Province,China(No.101595 and No.32830).
文摘Diffusion-weighted imaging(DWI)as a new technique of magnetic resonance imaging(MRI)is used to detect focal hepatic lesions.This study was designed to evaluate the significance of DWI to differentiate focal hepatic lesions less than 3 cm in diameter by the quantitation of apparent diffusion coefficient(ADC)values.METHODS:DWI using 1.5T MRI scanner unit was performed with a spin-echo single-shot echo planar imaging(EPI)in 56 cases of small focal hepatic lesions,including hepatocellular carcinoma(11),hepatic metastatic tumor(15),hepatic cavernous hemangioma(14),and hepatic cyst(16).The ADC values of these lesions were calculated respectively.The ratios of the ADC values of lesion/liver in hepatocellular carcinomas and hepatic metastatic tumors were also estimated.RESULTS:The mean ADC values(mm2/s)were(0.93±0.06)×10-3 in hepatocellular carcinomas,(1.09±0.18)×10-3 in hepatic metastatic tumors,(1.95±0.38)×10-3 in hepatic cavernous hemangiomas,and(3.18±0.33)×10-3 in hepatic cysts.The ratios of ADC values of lesion/liver were 0.90±0.06 and 1.15±0.14 in hepatocellular carcinoma and hepatic metastatic tumors respectively,which were significantly different(P<0.05).CONCLUSION:The measurement of ADC values and the ratios of ADC values of lesion/liver are helpful in MR diagnosis and differentiation of focal hepatic lesions.
文摘Prostate cancer(PCa)imaging forms an important part of PCa clinical management.Magnetic resonance imaging is the modality of choice for prostate imaging.Most of the current imaging assessment is qualitative i.e.,based on visual inspection and thus subjected to inter-observer disagreement.Quantitative imaging is better than qualitative assessment as it is more objective,and standardized,thus improving interobserver agreement.Apart from detecting PCa,few quantitative parameters may have potential to predict disease aggressiveness,and thus can be used for prognosis and deciding the course of management.There are various magnetic resonance imaging-based quantitative parameters and few of them are already part of PIRADS v.2.1.However,there are many other parameters that are under study and need further validation by rigorous multicenter studies before recommending them for routine clinical practice.This review intends to discuss the existing quantitative methods,recent developments,and novel techniques in detail.
基金supported by the National Natural Science Foundation of China[grant number 82001765]Supported by the program of Guangdong Provincial Clinical Research Center for Digestive Diseases(2020B1111170004).
文摘Background:Neoadjuvant chemotherapy(NCT)alone can achieve comparable treatment outcomes to chemoradiotherapy in locally advanced rectal cancer(LARC)patients.This study aimed to investigate the value of texture analysis(TA)in apparent diffusion coefficient(ADC)maps for identifying non-responders to NCT.Methods:This retrospective study included patients with LARC after NCT,and they were categorized into nonresponse group(pTRG 3)and response group(pTRG 0-2)based on pathological tumor regression grade(pTRG).Predictive texture features were extracted from pre-and post-treatment ADC maps to construct a TA model using RandomForest.The ADC model was developed by manually measuring pre-and post-treatment ADC values and calculating their changes.Simultaneously,subjective evaluations based on magnetic resonance imaging assessment of TRG were performed by two experienced radiologists.Model performance was compared using the area under the curve(AUC)and DeLong test.Results:A total of 299 patients from two centers were divided into three cohorts:the primary cohort(center A;n=194,with 36 non-responders and 158 responders),the internal validation cohort(center A;n=49,with 9 non-responders)and external validation cohort(center B;n=56,with 33 non-responders).The TA model was constructed by post_mean,mean_change,post_skewness,post_entropy,and entropy_change,which outperformed both the ADC model and subjective evaluations with an impressive AUC of 0.997(95%confidence interval[CI],0.975-1.000)in the primary cohort.Robust performances were observed in internal and external validation cohorts,with AUCs of 0.919(95%CI,0.805-0.978)and 0.938(95%CI,0.840-0.985),respectively.Conclusions:The TA model has the potential to serve as an imaging biomarker for identifying nonresponse to NCT in LARC patients,providing a valuable reference for these patients considering additional radiation therapy.
文摘目的分析动态增强磁共振成像(dynamic contrast enhanced magnetic resonance imaging,DCE-MRI)定量参数与表观扩散系数(apparent diffusion coefficient,ADC)联合诊断外周带前列腺癌的价值。方法选取2022年4月—2024年4月丹江口市第一医院收治的168例患者为研究对象,其中83例外周带前列腺癌患者纳入观察组,85例前列腺炎患者纳入对照组,另将同期于丹江口市第一医院行体检的88名健康体检者纳入健康组,均行DCE-MRI、扩散加权成像(diffusion weighted imaging,DWI)扫描,对比3组速率常数(rate constant,K_(ep))、容积转运常数(volume transfer constant,K_(trans))、血管外细胞外间隙体积分数(fractional extravascular extracellular space volume,V_(e))及ADC值;另描绘受试者工作曲线(receiver operating characteristic curve,ROC),分析K_(ep)、K_(trans)、V_(e)及ADC值单独或联合诊断外周带前列腺癌的价值。结果观察组的K_(ep)为(0.78±0.16)min、K_(trans)为(0.61±0.13)min,高于对照组的(0.53±0.10)min、(0.28±0.05)min,健康组的(0.14±0.02)min、(0.18±0.01)min,差异有统计学意义(P<0.001);观察组的V_(e)为(0.14±0.02)、ADC为(0.82±0.19)×10^(-3)mm^(2)/s,低于对照组的(0.18±0.02)、(1.06±0.18)×10^(-3)mm^(2)/s,健康组的(0.38±0.06)、(1.34±0.15)×10^(-3)mm^(2)/s,差异有统计学意义(P<0.001)。ROC结果显示,K_(ep)、K_(trans)、V_(e)及ADC值联合诊断外周带前列腺癌的曲线下面积(area under the curve,AUC)高于四者单一诊断(P<0.001)。结论DCE-MRI定量参数联合ADC可有效地诊断出外周带前列腺癌,存在一定的诊断价值。
